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The article presents a case study of a 12-year-old girl who was referred to a tertiary paediatric centre due to developed intermittent fevers and diagnoses revealed subacute bacterial endocarditis, occult osteomyelitis, cat scratch fever and rickettsial disease after series of examinations.

Purpose: To clarify the efficacy of adjustable suture strabismus surgery with sliding noose, we evaluated the accuracy of suture adjustment., Methods and Subjects: Thirty-four patients with various types of strabismus participated [age range: 12-79 years, range of far deviation: 4-123 prism diopters(PD)]. Under sub-Tenon anesthesia, a recession(with or without an additional resection or a muscle transposition) was performed with an adjustable suture(Guyton's procedure), and the suture was adjusted 6-24 hours after the surgery. Based on the initial postoperative examination performed 1-4 weeks(mean: 2.8 weeks) after the surgery, errors in the far deviation from the individual target were analyzed., Results: Twenty-six(76%) patients required suture adjustment 1-8 times. In 50% and 75% of our patients, the errors were within +/- 0.8 and +/- 2.0 PD, respectively, whereas 2(6%) patients with esotropia showed an undercorrection larger than 10 PD. Distribution of the errors was the same throughout the range of pre-operative deviation., Conclusion: By using the sliding noose type adjustable suture, a pin-point alignment of the eyes can be established in more than 50% of cases, at least, in the early post-operative period.